Opioid Update 2018
CenCal Health Pharmay Update
2018 Opioid Morphine Equivalent Dose (MED) Limit
CenCal Health and its Pharmacy Benefits Manager (MedImpact), are working together to communicate formulary changes to plan providers. With the approval of CenCal Health's Pharmacy & Therapeutics Committee and in coordination with MedImpact, CenCal Health has begun a Multiphase Implementation Plan to deter over-utilization of opioids, and update utilization management measures.
Effective 7/1/2018, CenCal Health will be implementing the following MED (Morphine Equivalent Dose) edits to help minimize the over utilization of opioids:
- MED (Morphine Equivalent Dose) >120mg
Soft-Edit at the pharmacy, can be overriden by the pharmacy
- MED (Morphine Equivalent Dose) >200mg
Hard-Stop at the Pharmacy, Prior Authorization would need to be submitted to justify the MED>200mg
In an effort to minimize disruption to members on Chronic Opioid Therapy, we are notifying providers of the MED limits that will be effective 7/1/2018. For providers with members over the future MED limit, please see the recommended actions below to ensure that there is no disruption in therapy.
Actions to Take:
- Assess patient and review diagnosis, treatment plan, and possible titration from medications and or willingness to obtain addiction treatment from the County Drug and Alcohol Services Program.
- Santa Barbara County: 1-888-868-1649
- San Luis Obispo County: 1-800-838-1381
2. If member's medical condition necessitates continuation of therapy above the 200mg MED, the following information must be submitted to obtain Prior Authorization, starting 7/1/2018:
- Diagnosis with medical justification
- Pain Assessment
- Urine Screening-Shows concordance with prescriptions
- Attempts made to titrate therapy
- Alternative treatment/therapies attempted
Please contact CenCal Health Pharmacy Services Department at (805) 562-1080 if you have any questions.
ADHD Formulary Update
CenCal Health's Formulary CNS Stimulant (ADHD medication) Quantity Limits
Effective 4/1/2018
|
Brand Name
|
Generic Name
|
Quantity limit
|
|
Adderall IR 5mg, 7.5mg, 10mg, 12.5mg, 15mg, and 20mg
|
Amphetamine Mixed Salts Tablet
|
3 units per day
|
|
Adderall IR 30mg
|
Amphetamine Mixed Salts Tablet
|
2 units per day
|
|
Adderall XR 5mg, 10mg, and 15mg
|
Amphetamine Mixed Salts Tablet
|
1 unit per day
|
|
Adderall XR 20mg, 25mg, and 30mg
|
Amphetamine Mixed Salts Tablet
|
2 units per day
|
|
Concerta 18mg and 27mg
|
Methylphenidate ER Tablet
|
1 unit per day
|
|
Concerta 36mg and 54mg
|
Methylphenidate ER Tablet
|
2 units per day
|
|
Dexedrine 5mg
|
Dextroamphetamine Tablet
|
2 units per day
|
|
Dexedrine 10mg
|
Dextroamphetamine Tablet
|
4 units per day
|
|
Dexedrine SR 5mg and 15mg
|
Dextroamphetamine ER Capsule
|
2 units per day
|
|
Dexedrine SR 10mg
|
Dextroamphetamine ER Capsule
|
4 units per day
|
|
Metadate CD 10mg, 20mg, 30mg, 40mg, 50mg, and 60mg
|
Methylphenidate ER Capsule
|
1 unit per day
|
|
Ritalin IR 5mg, 10mg, and 20mg
|
Methylphenidate Tablet
|
3 units per day
|
|
Ritalin LA 10mg, 20mg, and 40mg
|
Methylphenidate ER Capsule
|
1 unit per day
|
|
Ritalin LA 30mg Capsule
|
Methylphenidate ER Capsule
|
2 units per day
|
|
Ritalin SR 10mg and 20mg
|
Methylphenidate ER Tablet
|
3 units per day
|
|
Vyvanse 10mg, 20mg, 30mg, 40mg, 50mg, 60mg, and 70mg
|
Lisdexamfetamine Dimesylate Capsule
|
1 unit per day
|
- Brand Names are for reference purposes only and does not denote coverage. All brand name medications are non-formulary when the FDA approves an equivalent generic
- The medications listed above may have additional restrictions in the form of age limits and step therapy requirements
- Please contact CenCal Health Pharmacy Services Department at (805) 562-1080 if you have any questions or need any assistance
Formulary Updates
DUR: Educational Articles